Ukiah Valley Medical Center Adventist Health 2017 RECOMMENDED EMPIRIC ANTIMICROBIAL THERAPY ADULTS ONLY The choices listed below are provided as a guide to currently recommended empiric antibiotic therapy based on local sensitivity data Dosages listed are for patients with normal renal function. Call pharmacist (x7346) if patient has renal dysfunction, - a RESPIRATORY INFECTION Community Aequired/Non-ICU Patient: ‘Community Acquired/iCU patient (only): (5. pneumoniae, H. influenzae, Mycopiesma) (5: preumonize, Legionella) Ceftriaxone 1gm IV q24hr; PLUS Azithromycin 500mg | Ceftriaxone 1.gm IV q24hr PLUS Vor PO daily x 5 days OR Clarithromycin 500mg PO | Azithromycin 500mg IV or PO x 5 days OR qi12hr for 7 days OR Doxycycline 100mg IV or PO Levofloxacin 500mg IV q24hr 12 ‘Community Acquired/ICU patient (only) or Post Viral Pneumonia/Suspected MRSA or Influenza PLUS Pneumoi | Ceftriaxone 1gm IV q24nr PLUS Azithromycin 500mg IV or PO daily x5 days PLUS Vancomycin IV pharmacy to dose Health Care Associated! Nosocomial: (GNR, P. aeruginosa) | Cefepime tgm IV a8hr, PLUS Azithromycin 500mg IV or PO daily x 5 days OR Clarithromycin 500mg PO q12hr for 7 days OR Doxycycline 100mg IV or | PO qi2hr URINARY TRACT INFECTION Uncomplicated Cystitis: (Ecol, approx. 80%: Enterococcus; Proteus) | Cephalexin 500mg PO QID x3 days or Nitrofurantoin (MacroBID) 100mg PO q12hr (if CrCl>60mi/min) x3 days or Cefdinir 300mg PO qi2hr x3 days or TMP-SMX DS (Septra DS) 1 tab q12hr (for first time UTI oniy) x3 days For ESBL or VRE cystitis: Fosfomycin 3gm PO g48hr x 3 doses | Nosocomial Cystitis: | Pyelonephritis: | (Econ, Enterococcus, . seruginesa) | Ceftriaxone tgm IV q24hr OR Nitrofurantoin 100mg PO q12hr (if CrCl >60mLImin) | Ertapenem 1gm IV q24hr (if ESBL-producing organism) OR Fostomycin 3gm PO once | Pseudomonas) ade Gentamicin IV pharmacy to dose For Culture proven Pseudomonas ONLY: Ciprofloxacin 400mg IV q12hr OR 600mg PO q12hr x3 | days | Eor Culture Proven ESBL or VRE: | Fosfomycin 3am PO Gd8hr x 3 doses I INTRA-ABDOMINAL INFECTION ‘Community Acquired: | (enteric GNR, B. fragilis) Ceftriaxone 1gm IV q24hr PLUS Metronidazole 500mg IV q8hr OR Ertapenem tgm IV q24hr ycomial: (enteric GNR, 6 fragilis, Enterococcus) Piperacilintazobactam 3.375gm IV Shr ‘SKIN AND SKIN STRUCTURE INFECTION ‘Simple Celtulitis: Diabetic Foot Infections/Infected Decubitus Ulcer: (Staph, Entoric GNR, Bacteroides, usually polymicrobial) Doxycycline 100mg PONV qt2hr OR Empire Treatment: Vancomycin IV pharmacy to dose Ceftriaxone 1gm IV q24hr PLUS metronidazole 500mg IV q8hr: ture Pr y OR Ertapenem 1gm IV q24hr Cefazolin 1-2gm IV q8hr OR Nafeilin 2gm IV q4-6hr | For Suspected MASA (Recommend ID consult: | OR doxycycline 100mg IV oF PO qizhr Vancomycin IV pharmacy to dose PLUS Ceftriaxone 1gm IV q 24nr PLUS metronidazole 500m IV or PO q Shr | OR Ceftaoine PLUS metronidazole 500mg IV or PO q Bhr Sulars Provan Pevudomanes Cefepime tomiV aBhr PLUS Metronidazole 500mg IV of PO aBhr. OR Meropenem 1 gm IV ahr, OR Piperacilivtazobactam 3.375gm IV ph Cellulitis with Tissue Necrosis: ‘Necrotizing Fasciitis (Recommend iD consult) (Strep, Saph aureus) Daptomyein IV (6 mg/kg @24hr) PLUS Ceftiaxone gm IV qz4tr, Doxycyciine 100mg POV qt2hr OR OR Vancomycin lV per pharmacy protocol PLUS Ceftiaxone 1gm IV Vancomycin lV per pharmacy protoco! OR a24nr PLUS Ciindamycin 600mg IV aBhr Daptomycin IV (6 malkg 24h) SEPSIS ‘Sepsis with knoy tiology: Sepsis of undetermined etiology: Use applicable empiric guideline(s) above for source | Vancomycin IV Per Pharmacy Protocol PLUS of infection Meropenem 1 gm IV ght